This is the first in a series of posts in relation to Theatre Prometheus’ upcoming production of “Abortion Road Trip” by Rachel Lynette at this summer’s Capital Fringe Festival in Washington, DC. To support the work we do, donate to our fundraiser here.

CW: abortion, sexual assault

Thirty seven states in the USA do not require students to study math.

In North Dakota, there is only one in-state facility that provides cancer treatment.

Because men are on average taller than women, some believe that they should pay more for healthcare.

Imagine how ridiculous it would be if any one of the above statements were true. Now imagine that they were all true, and had serious ramifications on the health, wealth, and happiness of our entire nation.

Welcome to reproductive health in America.

In the US, more than half of states do not require that sex education be taught in schools, and only a quarter of states require that a sex ed curriculum be medically accurate [1]. In North Dakota, as of 2014, there was just 1 abortion provider for the entire state [2], which covers 69,000 square miles [3]. And until the Affordable Care Act, it was legal for insurers in many states to gender rate their packages, subjecting women to health care costs up to twice as high for the same care that men received.

With our production of Abortion Road Trip, we want to emphasize that along with keeping abortions legal, issues of education, practical access to abortions, treatment of mothers, health care policy, and intersections of race and class must all be addressed in order to achieve true reproductive justice.

Education

The US offers spotty sex education at best, and even where programs do exist in schools, nearly three-quarters of states allow parents to remove their children from a sex ed program -- even though one in four girls will experience a pregnancy between the ages of 15 and 19. Not surprisingly, the US sports one of the highest teen pregnancy rates among comparable countries.

Every state regulates sex education differently, and where you live can have a dramatic impact on the accuracy and breadth of information you receive. Only eight states require lessons on sex and HIV to be culturally appropriate and unbiased, and only two states, Louisiana and California, ban the promotion of religion in discussions of reproductive health. Thirty seven states have legislation that specifically requires teachers to cover abstinence, while only 18 states and the District of Columbia mandate a discussion of contraception.

You can check out the policies for your own state on the Guttmacher Institute website, which features a thorough compilation of content requirements throughout the US. You may be surprised by what is or isn’t being taught in your state.

Why should we care whether students have sex education? Well, comprehensive sex education works. After adopting better and more medically accurate sex education programs, California, for example, saw its teen birth rate drop by nearly 60% by 2013 [4]. We also need to remember that we live in a nation where 1 out of every 6 women has been the victim of an attempted or completed sexual assault [5], and sex education in schools is one way to promote consent and make sure that every student learns to recognize and condemn non-consensual sexual behavior (21 states and DC currently require sex education to include “avoiding coercive sex”).

Abortion Access

When considering the legality of abortion, most of us think of Roe v. Wade, but there are several cases that have come before the Supreme Court in the past 40 years that have created the rough guidelines for abortion-related legislation. According to these rulings:

- States cannot ban abortions at any stage of a pregnancy if they do not provide exceptions to protect the life and mental and physical health of the mother.

- States may not pass any legislation that dictates what constitutes that health, nor may they set a specific number of weeks after which the fetus is considered viable, or able to live outside of the womb; only a doctor can make those determinations on a case-by-case basis.

- Although many states require the participation of a second physician after a certain number of weeks, those mandates must include exceptions for emergencies, in which cases an immediate threat to a mother’s health needs only be determined by one doctor. [6]

In spite of these precedents, states have passed a glut of laws to limit the circumstances in which an abortion can be obtained -- some of which are in blatant defiance of the Supreme Court rulings. And the number of these laws being introduced has gone up dramatically since the Tea Party movement began in 2010: more than 25% of all abortion related policies since Roe v. Wade were enacted between 2011 and 2015.

Nearly every state bans abortions after a certain point in the pregnancy, and most states allow individual health care providers as well as larger institutions to refuse to perform the procedure. Sixteen states have mandated that, before she can have an abortion, the mother must receive counseling about fetal pain (for which there is no scientific consensus [7]), the link between abortion and breast cancer (which is blatantly false [8]), and mental health risks associated with abortion (also untrue [9]). More than half of the US has enacted mandatory waiting periods from 24 to 72 hours between consultation or counseling and the procedure, making it a multiple day affair; for people who can’t take time off from work, struggle to find childcare, or have no place to stay in the area, these waiting periods can become significant barriers to access. There are also countless laws aimed at abortion providers themselves that make it more difficult to operate a clinic, resulting in the closing of many smaller clinics in recent years -- one law in Texas shut down 13 clinics overnight [10].

This is just a drop in the bucket of abortion-related law -- you can read more about issues of funding, bans of certain types of procedures, and mandatory parental consent for minors here.

People Who Give Birth

The US is not a great supporter of people who decide against carrying their pregnancies to term… and unfortunately, it’s not much better for people who do decide to give birth. The US has the highest maternal mortality rates of any developed nation, and our numbers are on the rise. An excellent piece of investigative journalism by NPR explores the problem in great detail. According to their findings,

- Only 6% of state and federal grants set aside for both maternal and infant health will go towards maternal health

- Hospitals and medical schools focus almost exclusively on infant care: some students of maternal-fetal medicine have neverspent time in a labor unit, and many hospitals with high-quality neonatal care facilities are unequipped to handle maternal health emergencies

- There are no standardized policies for the monitoring and care of the person giving birth

- 60% of childbirth-related deaths are preventable

Meanwhile, even people who have completely healthy deliveries find plenty of obstacles. The US is one of only nine countries in the entire world that does not guarantee any paid maternal leave (let alone paternal leave) [11]. Potential parents, especially women, must often choose between starting a family and having a career and/or financial stability, since extended periods of unpaid leave can jeopardize their employment.

Everything is Inter-sectional

It’s important to remember that restrictive policies on reproductive health have a much worse impact on certain populations.

While abortions are still fairly accessible for wealthy women who live in urban areas, they can be practically impossible for poorer women to obtain, especially those living in rural areas. With the closing of so many abortion clinics, the lack of healthcare funding for abortions, and the mandatory waiting times that often require overnight stays, abortions can be a financial nightmare for the people who need them.

Teen pregnancy reinforces the cycle of poverty (poorer teens are more likely to become pregnant, and teens who become pregnant are more likely to remain poor), and these rates are higher for women of color than they are for white women [12]. For trans* and nonbinary individuals, it can be even harder to receive quality education and care.

As we move forward in the fight for reproductive justice, we must remember that injustice against one of us means no justice for any of us.

Share your story

Abortion Road Trip follows the journey of three women who drive from Texas to New Mexico for an abortion. It’s an incredible dark comedy that explores a lot… but there’s only so much that one play can cover, which is why we want to hear from you. From now until July, we’re accepting anonymous stories about your experiences with reproductive health and justice in America. We will then compile the submissions and post them together as the final installment of this blog series. We hope you’ll take a moment to share something with us, no matter how big or small it may seem to be. You can find the anonymous submission form here.